Too much fun in the sun can cause eye damage

Experts advise acquiring the sunglass habit early

At 5 p.m., as Jose Vega uncaps a tiny, $100 tube of ointment, he
thinks of work. As a chef at Jabinero's in Kansas City, Mo., he
should already be spreading ingredients — onions, peppers, meats —
across the restaurant stovetop. But instead, he is spreading
ointment over two rows of stitches in his eyes, and he can't come
close to that stove, or any stove, for five more weeks.

For another five weeks, his wife, Tanya, will have to keep the
family of five afloat with nonstop nightly shifts at St. Luke's
Hospital on top of nursing school classes. Vega, who had his third
pterygium ---- a layer of tissue that grows over the eye, starting
at the inside corner ---- removed last week, has to stay clear from
sun and heat for that long to recover.

The pterygiums, which Vega got from subjecting his eyes to too
much sunlight, are just one of many problems the sun can cause in
human eyes, said Vega's surgeon Carl Stout, of Discover Vision.
Others, he said, vary from keratitis ---- a sunburn on the eye ----
to a higher risk and a faster onset of more serious conditions,
such as cataracts and macular degeneration.

The danger for all eye damage from the sun is significantly
greater in summer. People are closer to the sun, and its light is
more intense. Activities such as water sports and games on concrete
only raise that risk by exposing people to reflected light,
too.

But unfortunately, a lack of awareness on the harm of sunlight
to eyes, and what people need for full protection, is also great,
Strout said. As a result, doctors are trying to educate their
patients more with each exam.

"It's just one more thing that we can protect ourselves from, if
we're a little aware of the problem," said Lee Duffner, a
Hollywood, Fla., ophthalmologist. "If we're totally unaware of the
problem, nobody's going to do anything."

No one knew

For Vega, the principal problem was a lack of education on eye
care. As a boy, he played soccer daily with friends in his hometown
of Guanaguanto, Mexico, without sunglasses. Later, as a young man,
he picked broccoli all day on a sunny farm in Soledad, Calif., with
his eyes still unprotected.

Eventually, his first pterygium at age 23 was his eyes' way of
saying "enough" and trying to block out any future harmful light on
their own.

Before a pterygium, Vega probably had a cinguecula, or an
"unsightly thickening" of the membrane, that often affects outdoor
workers like farmers and lifeguards. With more exposure, that
thickening worsened into the growths that Stout had to remove. Both
pterygiums and cingueculas are more unusual in that they are caused
by UVA light that that affects the conjunctiva membrane, covering
the white part of the eye, Duffner said.

UVA and UVB light

Of the sunlight's three kinds of ultraviolet, or UV, light ----
UVA, UVB and UVC ---- only the first two types, common for sunglass
labels, enter the atmosphere to be of concern. Most eye problems
occur because of UVB light, which has a shorter wavelength that can
penetrate the cornea.

Some of these conditions, like keratitis, can develop in a day
or afternoon, especially at a pool or lake where water reflects the
light. But the risk for most of them, and especially the more
serious ones like cataracts, macular degeneration or pterygiums,
rises gradually with light exposure: The damage is cumulative.

"The interesting thing about a lot of UV damage that occurs as
adults is you don't really see it until adulthood," said
optometrist Jason Rogers, of Drs. Hawks, Besler& Rogers in
Overland Park.

Rogers said he always recommends people use caution and always
wear sunglasses because they often can't perceive the level of harm
they are doing. The cornea has more nerve endings than any other
part of the body, but the damage often needs to reach the point of
a keratitis for people to feel pain.

Even with a keratitis, or sunburned eye, people often can't
pinpoint the pain they do feel, Rogers said. Many have been
swimming and assume the discomfort is caused by chlorine.

"They just don't know the relationship between how much exposure
causes retinal damage," he said. "They know it happens, but they
don't know how much at this point will do it."

Thought TV was culprit

Vega didn't know the sun was to blame for his growths until six
years after the first one began to form. As the growth grew inward,
he assumed it came from too much television. In Mexico, where his
home was smaller, he would watch TV up close, and he had seen his
friends' eyes redden with too much time in front of the screen.

But unlike his friends, Vega's eyes didn't improve when he would
leave the TV set. Instead, they got worse because by watching TV
less, he spent more time outdoors. Not until an exam with Dr. Stout
in 2005, Vega's first year in Kansas, did he learn that the sun
---- not TV ---- was the cause.

Now, of course, Vega wishes he could go back and wear
sunglasses. He has a big pair that covers the entire area around
his eyes, and he wears them every time he leaves the house. Twenty
years ago, they could have saved him two costly surgeries, years of
eye pain and his family's current financial hardship. But that
knowledge came too late.

Choose protection wisely

Doctors recommend people consider three main factors when buying
sunglasses: the lenses, their intended use and the frame. So far,
most of the country isn't paying attention.

According to an Eye-Q survey released recently by the American
Optometric Association, the majority of Americans prioritize style,
comfort or price ahead of protection.

For lenses, Stout advises that the most important element is UV
400 protective coating or, in percentages, lenses that provide 99
to 100 percent UVA and UVB protection.

Rogers said he always gives the same message: Unlike with skin
cancer, everyone needs the same level of UV protection, regardless
of ethnicity or eye color.

"You can look at different ethnic backgrounds and which one has
a higher risk for a certain type of skin cancer," he said. "But for
eye stuff, it's across the board."

As for lenses with full protection, Stout said people still have
a pretty wide range of flexibility. Some who spend a significant
amount of time by water often prefer polarized lenses because they
reduce glare. Others, who need precise far vision, like for
driving, pick amber because they seem to enhance details at a
distance.

Stout said he usually suggests a lens that is dark gray ---- the
color pilots use ---- because it allows you to see things as they
naturally appear.

Optometrist Melissa Hahn, of Olathe (Kan.) Family Vision, said
that, to ensure full protection, people should also be careful that
whatever lenses they pick are large enough. To be safe, she said
they should select a frame that wraps around the face and lenses
that cover the eyes and the surrounding skin and eyelids
completely.

If they don't, Rogers said people can actually develop skin
cancers around their eyes and on their eyelids. On the eyelid, he
said, a skin cancer can be much worse that it would be elsewhere
because the skin is so thin. Often, removing the cancer requires
major reconstructive surgery.

Rogers warned that price can be misleading. Frequently, people
will pick out an expensive designer pair of sunglasses and assume
the cost means the best lenses, too. But they're often just paying
for the frame and good optics, or clarity, in the lenses. The
harmful UVA and UVB rays still pass through.

"We have a UV meter in our office, and we'll have patients bring
in their lenses," Rogers said. "A lot of them don't have full
coverage at all."

However, Stout said, people can pick up a perfectly adequate
pair of sunglasses pretty cheaply. Most Walmart, CVS Pharmacy,
Costco and Sam's Club stores have inexpensive pairs with ample UV
protection.

"Any optometric or ophthalmologic facility that sells glasses,"
he added, "will have it for sure."

Start sunglasses early

In summer, doctors say kids are usually the ones most often
outside without sunglasses.

"This time of year, they tend to be outside a fair amount more
than adults," Rogers said. "And most of that time is by pools,
where 50 percent of light comes from reflective surfaces."

Kids are also the most vulnerable to sun damage. Under age 10,
Rogers said, their eyes can allow as much as 75 percent of UV light
to come into the eye. By age 25, the eyes become less translucent,
letting only 10 percent of light penetrate.

"The natural lens that's inside the eye, in kids, it's
super-clear, so clear they don't seem to be bothered as much by
light and glare," Rogers said. But that's when they especially need
to keep their eyes protected. "Because their lens is so clear," he
said, "they get more exposure."

To protect themselves, children should always wear sunglasses,
Stout said, and even consider using UV protective goggles while in
the water.

Hahn said parents should get them started as soon as possible.
"We actually recommend that they start wearing sunglasses even as a
child, an infant," she said.

Paying a steep price

For Jose Vega, the time when he was young and spent what he
calls la mayoria del tiempo afuera in Mexico has long passed. He
was just a normal boy then who loved to play soccer, like thousands
of others who love spending time outdoors.

But now Vega is paying a steep price for never covering his
eyes. The cost of each of the three surgeries he has undergone
since 1999 has been from $600 to $900.

Still, even after both eye surgeries and one repeat because the
tissue cut from the top of his right eye didn't take to the side
surface as planned, he could someday need more surgeries. But Vega
isn't sure he would accept that, although it would mean he could
live the rest of his life with a ball of scar tissue in his
eyes.

"He's always been the main income. And then, to lose that main
income, it's been tough," said Tanya, who now often works 7 p.m. to
7 a.m. and then attends nursing school from 8 a.m. to 1 p.m. before
another night shift.

Vega is supposed to spend two full months off work, but he has
decided to take only six weeks to relieve his wife, Tanya, sooner.
Two weeks before he starts, he says, his kids will return home from
their summer in Mexico. They'll find three new pairs of 100 percent
UV protective sunglasses waiting for them.